Lucas Lacerda de Souza

Central mucoepidermoid carcinoma: An up-to-date analysis of 147 cases and review of prognostic factors

OBJECTIVEnTo integrate the available data published on central mucoepidermoid carcinoma (CMC) into a comprehensive analysis of its clinical aspects, histology, treatment, and prognostic factors.nnnMETHODSnAn electronic search was undertaken in July 2017. Eligibility criteria for publications included having clinical, histological, treatment, and time of follow-up data to confirm the diagnosis.nnnRESULTSnIn addition, gender, histological grade, conservative treatment, and lymph node metastasis were significant independent prognostic factors.nnnCONCLUSIONnMale patients with histological grade III CMC of the jaw bone, who used conservative treatment as the main treatment, and presented with lymph node metastasis, were more likely to have a worse prognosis.

Comparative Therapeutic Effects of Minocycline Treatment and Bone Marrow Mononuclear Cell Transplantation following Striatal Stroke

We explored the comparative effects of minocycline treatment and intrastriatal BMMC transplantation after experimental striatal stroke in adult rats. Male Wistar adult rats were divided as follows: saline-treated (N = 5), minocycline-treated (N = 5), and BMMC-transplanted (N = 5) animals. Animals received intrastriatal microinjections of 80u2009pmol of endothelin-1 (ET-1). Behavioral tests were performed at 1, 3, and 7 days postischemia. Animals were treated with minocycline (50u2009mg/kg, i.p.) or intrastriatal transplants of 106 BMMCs at 24u2009h postischemia. Animals were perfused at 7 days after ischemic induction. Coronal sections were stained with cresyl violet for gross histopathological analysis and immunolabeled for the identification of neuronal bodies (NeuN), activated microglia/macrophages (ED1), and apoptotic cells (active caspase-3). BMMC transplantation and minocycline reduced the number of ED1+ cells (p < 0.05, ANOVA-Tukey), but BMMC afforded better results. Both treatments afforded comparable levels of neuronal preservation compared to control (p > 0.05). BMMC transplantation induced a higher decrease in the number of apoptotic cells compared to control and minocycline treatment. Both therapeutic approaches improved functional recovery in ischemic animals. The results suggest that BMMC transplantation is more effective in modulating microglial activation and reducing apoptotic cell death than minocycline, although both treatments are equally efficacious on improving neuronal preservation.

Oral and maxillofacial manifestations of chronic kidney disease–mineral and bone disorder: a multicenter retrospective study

OBJECTIVEnTo describe the oral and maxillofacial manifestations of patients diagnosed with chronic kidney disease-mineral and bone disorders.nnnSTUDY DESIGNnOver a 13-year period, clinicopathologic data of patients diagnosed with CKD-MBD who had oral and maxillofacial alterations were retrieved from the files of 4 Brazilian institutions. Data included clinical, radiographic, microscopic, and biochemical findings; treatment employed; and follow-up status.nnnRESULTSnTwenty-one cases were identified, with 13 patients diagnosed as brown tumor of hyperparathyroidism (BTH) and 8 as osteitis fibrosa/renal osteodystrophy (OF/RO) (4 of them clinically consistent with Sagliker syndrome). The mean age was 32.7 years, and the mandible was the most affected site (42.8%). OF/RO had an ill-defined ground glass radiographic appearance, and BTH produced well-defined radiolucent images. Biochemically the following mean values were obtained: parathormone 1511.07u2009pg/mL, calcium 9.25u2009mg/dL, phosphorus 5.19u2009mg/dL, alkaline phosphatase 941.55u2009U/L, urea 125.42u2009mg/dL, and creatinine 7.14u2009mg/dL. Treatment comprised vitamin D and calcium intake, parathyroidectomy, hemodialysis, renal transplantation, and local surgery. During follow-up, 5 patients with BTH were free of lesions, whereas 2 affected by OF/RO/Sagliker syndrome died.nnnCONCLUSIONSnOral and maxillofacial manifestations of BTH and OF/RO are uncommon, but they can be associated with an important life-threatening scenario.

Head and neck giant keratoacanthoma: a case report

Article history: Received 23 December 2017 Accepted 4 August 2018 Available online 10 September 2018 Keratoacanthoma is a low-grade tumor originated from the pilosebaceous glands that nearly resembles squamous cell carcinoma under histopathological analysis. Giant keratoacanthoma is a rare subtype with a size exceeding 2 cm, with a high aggressiveness potential. Head and neck giant keratoacanthomas are uncommon and mainly affect male patients with a mean age of 59.1 years old, usually affecting the nose. Excision of the lesion is the preferred treatment for giant keratoacanthoma. The aim of this study is to analyze the clinicopathological characteristics of head and neck giant keratoacanthoma by reviewing the previously published English literature and reporting one new case of a rare lesion affecting the lower lip. (Rev Port Estomatol Med Dent Cir Maxilofac. 2018;59(2):115-118)

Drug protocols for patients with special needs: a review of the literature

There is a great need for dental surgeons to be trained to proceed with patients needing some kind of special care. This study aimed to perform a review of the literature on drug protocols concerning how to treat patients with special needs, within the different areas in which dentists may be engaged. The methodology employed was to review articles dealing with the subjects of diabetes mellitus, chronic renal failure, hemophilia, cardiac patients, which were focused on areas of dentistry. A total of 33 articles were selected. Several specific protocols were found on how to act during a consultation of several systemic diseases or in special cases, in order to achieve success during treatment, to avoid drug interactions or to create emergency situations. It was possible, in some cases, to find a consensus between the sequences or the drug of first choice for patients. Serious errors can occur if a dentist is not capable in serious cases. The creation of a protocol for these patients in the different dental specialties would reduce the number of failed treatments, thus increasing the safety and effectiveness of the treatments. Indexing terms: Dentistry. Pharmacology; Protocols. Disabled persons.

Effect of 17-allylamino-17-demethoxygeldanamycin (17-AAG) on Akt protein expression is more effective in head and neck cancer cell lineages that retain PTEN protein expression

OBJECTIVESnThe aim of this study was to evaluate the expression of Akt, PTEN, Mdm2 and p53 proteins in three different head and neck squamous cell carcinoma (HNSCC) cell lines (HN6, HN19 and HN30), all of them treated with epidermal growth factor (EGF) and 17-allylamino-17-demethoxygeldanamycin (17-AAG), an inhibitor of Hsp90 protein.nnnMATERIAL AND METHODSnImmunofluorescence and western blot were performed in order to analyze the location and quantification, respectively, of proteins under the action 17-AAG and EGF.nnnRESULTSnTreatment with EGF resulted in increased levels of Akt, PTEN and p53 in all cell lineages. The expression of Mdm2 was constant in HN30 and HN6 lineages, while in HN19 showed slightly decreased expression. Under the action 17-AAG, in HN6 and HN19, the expression of PTEN and p53 proteins was suppressed, while Akt and Mdm2 expression was reduced. Finally, in the HN30 cell lineage were absolute absence of expression of Akt, Mdm2 and p53 and decreased expression of PTEN.nnnCONCLUSIONnThese data allow us to speculate on the particular utility of 17-AAG for HNSCC treatment through the inhibition of Akt protein expression, especially in the cases that retain the expression of PTEN protein.

Clinicopathological analysis of oral plasmablastic lymphoma: A systematic review

BACKGROUNDnPlasmablastic lymphoma (PBL) is a high-grade lymphoma that often affects the oral cavity of HIV-positive patients; however, its prognostic determinants remain unknown.nnnPURPOSEnTo integrate the available data on oral PBL to determine its clinicopathological features and to identify potential prognostic factors.nnnMETHODSnAn electronic systematic review was performed using multiple databases with a specific search strategy in February 2018. Inclusion criteria comprised cases diagnosed as PBL affecting the oral cavity and gnathic bones with sufficient data to confirm the diagnoses.nnnRESULTSnA total of 70 publications were included, representing 153 cases. Oral PBL predominantly affected HIV-positive males (76.4%). EBV was observed in 63.4% of the cases. The gingiva was the most involved site and the lesion usually presented as an asymptomatic swelling. Most cases were classified as stage I (21.6%), and chemotherapy alone was applied in 28.8% of the cases. There was a significant association between HIV and EBV infections, and cases affecting HIV-negative patients were more common in older individuals. Cumulative survival of the patients achieved 42.4% and 33.5% after 2 and 5xa0years, respectively. Although there were no statistically significant clinicopathological parameters in the univariate analysis, the multivariate Cox regression model demonstrated that EBV-positive status, presence of B-symptoms, and chemotherapy alone were independent prognostic determinants of a poor prognosis.nnnCONCLUSIONnOral PBL is an aggressive neoplasm with low survival rates, which is influenced by the presence of EBV, presence of B-symptoms, and with the use of chemotherapy only.

Central odontogenic fibroma: An updated systematic review of cases reported in the literature with emphasis on recurrence influencing factors

PURPOSEnTo integrate the available data published on central odontogenic fibroma (COF) into a comprehensive analysis of its clinical/radiologic/histological features.nnnMETHODSnAn electronic search was undertaken in September 2017. Eligibility criteria included publications reporting cases of COF having enough clinical, radiological and histological information to confirm the diagnosis. Demographic data, lesion site and size, treatment approach, and recurrence were analysed. The cases included in the analysis presented follow-up time. Concerning recurrence analysis, tumour location, cortical bone perforation, lesion locularity, radiopacities, lesions associated with a tooth, tooth displacement, histological type and treatment used were evaluated.nnnRESULTSnEighty-three publications reporting 173 COFs were included. Lesions were slightly more prevalent in men than women (M:u200aF - 1.13:u200a1); mean age was 31.6 years, with the highest prevalence in the second decade of life. Lesions were more prevalent in the posterior mandible. The difference in recurrence rate (when information about recurrence was provided) presented a statistically significant result for COF for location, cortical bone perforation and locularity of the lesion.nnnCONCLUSIONSnOur paper highlights that patients with COF who present a lesion located in the maxilla with multilocular aspects and cortical bone perforation tend to show a higher recurrence rate.

Congenital Ranula: A Case Report and Literature Review

Ranula consists of a pathological process induced by ductal disruption of the minor salivary glands followed by extravasation of mucous material surrounding adjacent structures. A swelling causing breathing and feeding problems associated with tongue displacement is frequently observed. It is a disease that generally involves the younger age group. In newborns congenital ranula may occur, an uncommon variance that differs from common ranula by not relate to post-traumatic reactions. There are reports that indicate a salivary gland duct atresia as the main cause of this pathology. The aim of this study is to analyze the clinicopathological characteristics of congenital ranula by reporting a new case report of this salivary cyst and reviewing the case reports previously published in the English literature.

Nuclear metallothionein in oral squamous cell carcinoma: clinicopathological parameters and patient survival

The aim of this study was to identify the immunoexpression of methallothionein in oral squamous cell carcinoma as well as to address the correlation with clinical features, histological grade and patient survival. Samples were collected from 93 patients with tongue squamous cell carcinoma who presented for follow-up. Immunohistochemical expression of methallothionein in all groups was performed. The scoring system has previously been published by Tsurutani in 2005, which is based on intensity and distribution of staining. We used Kappa index to evaluate the degree of observers agreement under metallothionein immunostaining and histological grade. Associations between methallothionein expression and clinical parameters (age, gender, smoking, tumor size, lymph node metastasis and disease stage) were examined for statistical significance using the chi-squared test. The overall survival rates were estimated by the Kaplan-Meier method and the relationship between protein expression and survival was compared using the log-rank test (p < 0.05). Our results showed no statistically significant association between methallothionein immunostaining and the selected clinicopathological variables. Immunohistochemistry results showed positive nuclear immunostaining for metallothionein in 62,37% (58/93) and negative for metallothionein 37,63% (35/93). The degree of examiners agreement by Kappa varied from substantial to perfect and both metallothionein immunostaining and histological grade were explored. The present study suggests that positive methallothionein expression found in tongue squamous cell carcinoma may not help to predict survival in the analyzed samples, as well as no relation between the protein and histological grade and clinical features was observed. In conclusion, the present study suggests that metallothionein is not associated with tongue squamous cell carcinoma clinicopathological characteristics and aggressiveness.